Integrating Primary Care and Public Health Approaches: Outcomes of the TX CORD Project Deanna Hoelscher, PhD, RD, LD Michael & Susan Dell Center for Healthy Living University of Texas School of Public Health Southern Obesity Summit, November 14, 2016 Deanna.M.Hoelscher@uth.tmc.edu | 512.391.2510 @deannahoelscher

TX CORD Study Design Hoelscher et al., 2015

Primary Prevention versus Secondary Prevention Efforts targeting the entire population1 Healthy weight as well as overweight/obese children Prevention of child obesity Environmental and programmatic changes SCT, SEM, MI Efforts focus on overweight and obese children Prevent disease progression and development of co-morbidities More intensive programs2 SCT Multi-component behavioral interventions that offered medium- (26 to 75 hours) to high-intensity (>75 hours) contact time, were the most effective, and consistently resulted in small to moderate improvements in weight status (mean difference in BMI change: 2.4). However, evidence is more limited for long-term maintenance of this BMI improvement at or beyond 12-months post-treatment. Finally this review found no evidence of adverse effects on growth, eating disorder pathology, or mental health with behavioral interventions in a limited number of reports. US Preventive Services Taskforce (Whitlock et al., Pediatrics, 2010) 1Hoelscher et al., 2013; 2Whitlock et al., 2010

TX CORD CATCHMENT AREAS AUSTIN, TX. HOUSTON, TX. TX CORD CATCHMENT AREAS Index was based on (1) % African American/black, (2) % Hispanic, (3) % >25 yr with <12th grade education, (4) % < 185% poverty, families with <18 yr olds; (5) % house <100K, with a range of 5-25 Oluyomi et al., 2015

Secondary Prevention Within Primary Prevention areas RCT begins at Provider (Next Steps) n = 576 (288 Intervention, 288 Comparison) Source: Sacher et al., 2010; Kelder et al., 2005; Evans et al., 2012; Ranjit et al., under review

Primary Outcome: %95th BMI xxx00.#####.ppt 4/30/2018 Primary Outcome: %95th BMI * ** ** ** ** ** * ** * Arm-by-time (3 month vs baseline) interaction, (p<0.05) ** Time effect (p<0.05) **

Results – Intervention Dosage xxx00.#####.ppt 4/30/2018 Results – Intervention Dosage NEXT STEPS* MEND/CATCH** 2-5 y 6-8 y 9-12 y Dosage (#sessions) 0.2 ± 0.4 4 ± 3 10 ± 6 8 ± 5 Dosage (%) 8 ± 21 11 ± 21 9 ± 21 46 ± 34 58 ± 33 47 ± 30 **Maximum sessions offered in MEND/CATCH 2-5 y = 9 MEND/CATCH 6-8, 9-12 y = 18 *Maximum sessions offered in NEXT STEPS = 2

Conclusions Summary of results A total of 549 families with overweight or obese children, 2-12 y, randomized into MEND/CATCH or NEXT STEPS Low income families, predominately Hispanic and Black 78% retention at 3 months Significant intervention effects MEND/CATCH relative to NEXT STEPS at 3 months: BMI z-score for 6- 8 y, and 9-12 y Waist and waist:height for 9-12 y Fat mass for 9-12 y Diastolic blood pressure for 9-12 y Secondary Prevention Programs can decrease BMI with elementary school children (ages 6-8 and perhaps 9-12) Effects are greater with greater dose Combining Primary and Secondary Prevention Efforts is challenging in a large urban setting

TX CORD Acknowledgements Texas Center for the Prevention and Treatment of Childhood Obesity This research was supported by cooperative agreement RFA-DP-11-007 from the Centers for Disease Control and Prevention.  The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention. Additional support was provided by the Michael and Susan Dell Center for Healthy Living. This work is a publication of the United States Department of Agriculture (USDA/ARS) Children’s Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, and had been funded in part with federal funds from the USDA/ARS under Cooperative Agreement No. 58-6250-0-008. The contents of this publication do not necessarily reflect the views or policies of the USDA, nor does mention of trade names, commercial products, or organizations imply endorsement from the U.S. government. Investigators: Nancy Butte (Co-PI), Sarah Barlow, Steve Kelder, Elizabeth Vandewater, Shreela Sharma, Courtney Byrd-Williams, Casey Durand, Abiodun Oluyomi, Brett Spenser, Cari Browning, Paul Sacher, Terry Huang, Stephen Pont, Eric Finkelstein